Bilateral ocular deposit of chlorpromazine / Depósito ocular bilateral de clorpromazina

ABSTRACT Chlorpromazine is a medication widely used in psychiatry for the treatment of psychoses, especially schizophrenia. Since 1964, published articles have been correlating this medication with the appearance of ocular alterations. In this paper, we report the case of a 65-year-old patient with ocular effects due to long-term therapy with chlorpromazine. Biomicroscopy of both eyes presented diffuse granular brown deposits, most prominent at the deep stroma and corneal endothelium level. Also showed anterior subcapsular brown deposits with a stellate pattern in the lens. The total amount exceeds 2.000g (significant for the ocular alterations described) considering the patient's daily dosage of chlorpromazine of 300mg for ten years. After performing complete ophthalmic evaluation and discarding other causes for the ocular deposits, we diagnosed a secondary corneal deposit and cataract due to the use of chlorpromazine. This case reinforces the importance of periodic follow-up with an ophthalmologist for chlorpromazine users to trace ocular changes, heeding the exposure time and its dosage.

RESUMO A clorpromazina é uma medicação muito empregada na psiquiatria para tratamento de psicoses, especialmente em casos de esquizofrenia. Desde 1964 existem artigos publicados que correlacionam o uso dessa medicação com o aparecimento de alterações oculares. Neste trabalho, relatamos o caso de um paciente de 65 anos com efeitos oculares devido à terapia de longo prazo com clorpromazina. A biomicroscopia de ambos os olhos apresentou depósitos granulares difusos e de cor marrom, mais proeminente ao nível do estroma profundo e do endotélio da córnea, além de depósitos castanhos subcapsulares anteriores centrais em um padrão estrelado no cristalino. Considerando a dose diária de clorpromazina de 300mg por 10 anos usada pelo paciente, a quantidade total ultrapassa 2.000g (dose considerada significativa para as alterações oculares descritas). Após avaliação oftalmológica completa e descartado outras causas desses depósitos oculares, foram diagnosticados depósito corneano e catarata secundários ao uso de clorpromazina. O caso apresentado reforça a importância do acompanhamento oftalmolÓgico periÓdico de usuários de clorpromazina para o rastreio de alteraçÕes oculares, atentando-se ao tempo de exposição à droga e à posologia da mesma.

Acquired anterior staphyloma after corneal ulcer associated with the use of crack.

We describe an unusual case of acquired anterior staphyloma in a patient addicted to crack cocaine. At the beginning of his crack cocaine abuse, he noticed redness and irritation of his eyes. Over the next 4 months, the patient also noticed the onset of decreasing visual acuity in his right eye (OD). Initially, his visual acuity was light perception in OD, and slit-lamp examination revealed a corneal infiltrate with a peripheral perforation and an iris prolapse. The patient was hospitalized to ensure compliance with the prescribed treatment and was advised to undergo therapeutic keratoplasty; however, the patient left the hospital against medical advice and was lost to follow-up for the next 6 months. He returned with complaints of photophobia and the inability to close his right eyelids. At this time, his cornea had developed an anterior staphyloma and required a sclerokeratoplasty. Following surgery, the patient was again lost to follow-up.

Acquired anterior staphyloma after corneal ulcer associated with the use of crack / Estafiloma anterior adquirido após úlcera de córnea associado a uso de crack

ABSTRACT We describe an unusual case of acquired anterior staphyloma in a patient addicted to crack cocaine. At the beginning of his crack cocaine abuse, he noticed redness and irritation of his eyes. Over the next 4 months, the patient also noticed the onset of decreasing visual acuity in his right eye (OD). Initially, his visual acuity was light perception in OD, and slit-lamp examination revealed a corneal infiltrate with a peripheral perforation and an iris prolapse. The patient was hospitalized to ensure compliance with the prescribed treatment and was advised to undergo therapeutic keratoplasty; however, the patient left the hospital against medical advice and was lost to follow-up for the next 6 months. He returned with complaints of photophobia and the inability to close his right eyelids. At this time, his cornea had developed an anterior staphyloma and required a sclerokeratoplasty. Following surgery, the patient was again lost to follow-up.

RESUMO Descrevemos um raro caso de estafiloma anterior adquirido em um paciente viciado em crack. No início do uso do crack, paciente observou hiperemia e irritação nos seus olhos. Durante os próximos 4 meses, evoluiu com piora progressiva da visão em seu olho direito (OD). Inicialmente, sua visão no OD era de percepção luminosa e ao exame de biomicroscopia observava-se um importante infiltrado corneano com uma perfuração periférica e hérnia de íris. O paciente foi hospitalizado para garantir seu correto tratamento e indicado ceratoplastia terapêutica; no entanto, o paciente abandou o hospital e ficou 6 meses sem acompanhamento. Após esse período, paciente retornou queixando-se de importante fotofobia e inabilidade em ocluir o OD. Neste momento, sua córnea havia desenvolvido um importante estafiloma anterior e necessitou de uma escleroceratoplastia no OD. Após a cirurgia, mais uma vez o paciente abandonou o tratamento e perdeu o seguimento pós-operatório.

Effect of benzalkonium chloride-free travoprost on intraocular pressure and ocular surface symptoms in patients with glaucoma previously on latanoprost: an open-label study.

BACKGROUND: Prostaglandin analogs reduce intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension; however, these medications may affect the ocular surface and elicit ocular discomfort when preserved with benzalkonium chloride (BAK). METHODS: This was an open-label, single-arm study conducted in Latin America from February 2012 to May 2013. Patients with open-angle glaucoma or ocular hypertension who were intolerant of latanoprost 0.005 % were transitioned to receive once-daily BAK-free travoprost 0.004 % containing polyquaternium-1 (Travatan® preserved with POLYQUAD® [PQ], Alcon Laboratories, Inc; Fort Worth, TX) for 12 weeks. Mean change in IOP from baseline (primary efficacy endpoint) and the percentage of patients who achieved a target IOP of ≤18 mmHg were evaluated at all on-therapy visits. Ocular hyperemia, patient preference, and self-projected adherence were assessed at week 12. Adverse events (AEs) were monitored throughout the study. RESULTS: All enrolled patients were included in the analysis (n = 191); the majority of patients (90.6 %, n = 173/191) completed the study. Mean (SD) patient age was 67.5 (11.3) years, and mean baseline IOP was 14.8 mmHg. Mean IOP was reduced by 0.94 mmHg at week 6 and by 1.09 mmHg at week 12 (P < 0.001 for both). A greater percentage of patients achieved a target IOP of ≤18 mmHg at week 6 (93.1 %; n = 163/175) and week 12 (93.3 %; n = 166/178) compared with baseline (89.5 %; n = 171/191). There was a 10.5 % increase in the percentage of patients with "none/trace" amounts of hyperemia. Most patients preferred the study medication (81.5 %; n = 141/173) and were confident that they would adhere to their preferred medication (90.8 %; n = 157/173). No serious AEs were reported, and eye irritation (3.7 %; n = 7/191) was the most common treatment-related AE. CONCLUSIONS: Transitioning from BAK-containing latanoprost 0.005 % to BAK-free travoprost 0.004 % preserved with PQ reduced IOP in patients with open-angle glaucoma or ocular hypertension who were intolerant of latanoprost. BAK-free travoprost 0.004 % is a viable alternative for patients who require switching their IOP-lowering medications because of tolerability issues. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT01510145.

Effects of antiproteolytic agents on corneal epithelial viability and matrix metalloproteinase-2 and metalloproteinase-9 activity in alkali-burned corneas of rats.

OBJECTIVE: To evaluate the effects of agents on corneal re-epithelization and metalloproteinase-2 and metalloproteinase-9 (MMP-2 and MMP-9) activities in corneas of rats submitted to ulceration. ANIMALS STUDIED: Ninety eight healthy rats. PROCEDURES: Corneal ulcers were created using 1N NaOH in their left eye. Eyes were treated every 6 h with 1% ethylenediaminetetraacetic acid (EDTA), 3% chondroitin sulfate (CS), 10% N-acetylcysteine NAc and saline (S) at 6-h intervals. Corneas were stained with fluorescein and photographed at the same time points. Following 20 h and 40-42 h of corneal injury, corneas were processed for scanning electron microscopy (SEM) to quantify microvilli density, and MMPs activities were analyzed using zymography. RESULTS: The percentage of wound area and the time in hours for corneal re-epithelization did not differ significantly among treatment groups (P > 0.05). In first and the second moments, latent MMP-2 was significantly elevated in the eyes treated with NAC and CS (P < 0.001). Active MMP-2 did not change significantly among treatment groups in the first moment (P > 0.05); significantly higher activity was observed in the second moment in the eyes treated with CS (P <0.001). In the second moment, latent MMP-9 decreased significantly in eyes treated with EDTA and S (P < 0.01). Microvilli corneal density did not change significantly between healthy subjects and treatment groups (P > 0.05). CONCLUSION: Any of the studied substances did not accelerate corneal re-epithelization and did not add protection to the corneal microvilli. Significant higher levels of active form of MMP-2 in 3% chondroitin sulfate-treated group may indicate that the agent acts as substrate for such enzyme. At the end of the experiment, 1% EDTA was the most efficient agent to inhibit significantly the latent form of MMP-9. However, any of the substances add benefit over saline on reducing the proteolytic activity in the cornea of rats after alkali injury.

The prevalence of ocular surface complaints in Brazilian patients with glaucoma or ocular hypertension.

PURPOSE: To examine the prevalence of ocular surface complaints in Brazilian patients with glaucoma or ocular hypertension who used topical intraocular pressure (IOP)-lowering regimens. METHODS: In this multicenter, noninterventional, single-visit study, adults with glaucoma or ocular hypertension treated with an IOP-lowering regimen were administered the 12-item ocular surface disease index (OSDI) questionnaire. Each response was scored on a 5-point scale, with 0 indicating symptom present none of the time and 4 indicating symptom present all of the time. The average of the 12 item responses for each patient was transformed to a scale from 0 to 100, with higher scores representing worse disabilities. OSDI results then were categorized as absence of OSD (scores of 0-12), mild OSD (scores of 13-22), moderate OSD (scores of 23-32), or severe OSD (scores of 33100). RESULTS: The 173 enrolled patients had a mean age of 61.2 years, were women in 65.3% of cases, and had glaucoma in 89.0% of cases and ocular hypertension in 11.0% of cases. OSDI scores for 158 patients using 1 IOP-lowering therapy indicated no OSD in 37.3% of patients (59/158), mild OSD in 20.9% (33/158), moderate OSD in 17.1% (27/158), and severe OSD in 24.7% (39/158). For the 120 patients using 1 IOP-lowering medication and having a known duration of diagnosis of glaucoma or ocular hypertension, mean OSDI scores were numerically higher (worse) for the 39 patients with a diagnosis ≥6 years long (score 25 [± 20], indicating moderate OSD) than for the 81 patients with a diagnosis lasting <6 years (score 22 [± 20], indicating mild OSD); however, no significant differences in OSDI scores by duration of diagnosis were evident in means (P=0.49), distributions (P≥0.26), or correlation (P=0.77). CONCLUSIONS: A large proportion of Brazilian patients treated with 1 IOP-lowering therapy had some ocular surface complaints.

The prevalence of ocular surface complaints in Brazilian patients with glaucoma or ocular hypertension / Prevalência de sintomas da doença da superfície ocular em pacientes brasileiros com glaucoma ou hipertensão ocular

PURPOSE: To examine the prevalence of ocular surface complaints in Brazilian patients with glaucoma or ocular hypertension who used topical intraocular pressure (IOP)-lowering regimens. METHODS: In this multicenter, noninterventional, single-visit study, adults with glaucoma or ocular hypertension treated with an IOP-lowering regimen were administered the 12-item ocular surface disease index (OSDI) questionnaire. Each response was scored on a 5-point scale, with 0 indicating symptom present none of the time and 4 indicating symptom present all of the time. The average of the 12 item responses for each patient was transformed to a scale from 0 to 100, with higher scores representing worse disabilities. OSDI results then were categorized as absence of OSD (scores of 0-12), mild OSD (scores of 13-22), moderate OSD (scores of 23-32), or severe OSD (scores of 33100). RESULTS: The 173 enrolled patients had a mean age of 61.2 years, were women in 65.3% of cases, and had glaucoma in 89.0% of cases and ocular hypertension in 11.0% of cases. OSDI scores for 158 patients using 1 IOP-lowering therapy indicated no OSD in 37.3% of patients (59/158), mild OSD in 20.9% (33/158), moderate OSD in 17.1% (27/158), and severe OSD in 24.7% (39/158). For the 120 patients using 1 IOP-lowering medication and having a known duration of diagnosis of glaucoma or ocular hypertension, mean OSDI scores were numerically higher (worse) for the 39 patients with a diagnosis ≥6 years long (score 25 [± 20], indicating moderate OSD) than for the 81 patients with a diagnosis lasting <6 years (score 22 [± 20], indicating mild OSD); however, no significant differences in OSDI scores by duration of diagnosis were evident in means (P=0.49), distributions (P≥0.26), or correlation (P=0.77). CONCLUSIONS: A large proportion of Brazilian patients treated with 1 IOP-lowering therapy had some ocular surface complaints.

OBJETIVO: Avaliar a prevalência de sintomas decorrentes de doença de superfície ocular (DSO) em pacientes brasileiros com glaucoma ou hipertensão ocular que utilizam tratamento ocular tópico para redução da pressão intraocular (PIO). MÉTODO: Neste estudo multicêntrico, não intervencional de uma única visita, pacientes adultos com glaucoma ou hipertensão ocular em tratamento para redução da pressão intraocular (PIO) responderam aos 12 itens do questionário "índice de doença da superfície ocular" (OSDI). Cada resposta foi pontuada numa escala de 5 pontos, com 0 (zero) indicando a ausência de sintomas e 4 indicando sintomas presentes todo o tempo. A média de respostas dos 12 itens para cada paciente foi transformada numa escala de 0 a 100, com pontuações mais elevadas representando piores deficiências. Os resultados do OSDI foram categorizados como ausência de DSO (pontuação de 0-12), DSO leve (pontuação de 13-22), DSO moderada (pontuação de 23-32) ou DSO grave (pontuação de 33-100). RESULTADOS: Os 173 pacientes incluídos apresentavam idade média de 61,2 anos, 65,3% eram mulheres (65,3%), tinham glaucoma em 89,0% dos casos e hipertensão ocular em 11,0% dos casos. As pontuações do OSDI para os 158 pacientes utilizando uma medicação para redução da PIO indicaram "DSO ausente" em 37,3% dos pacientes (59/158), "DSO leve" em 20,9% (33/158), "DSO moderada" em 17,1% (27/158) e "DSO grave" em 24,7% (39/158). Para os 120 pacientes utilizando medicação redutora da PIO e com duração conhecida do diagnóstico de glaucoma ou hipertensão ocular, a pontuação média do OSDI foi numericamente superior (pior) para 39 pacientes com diagnóstico realizado há mais de 6 anos (pontuação 25 [± 20] indicando DSO moderado) do que para 81 pacientes com o diagnóstico realizado há menos de 6 anos (pontuação 22 [± 20] indicando DSO leve); no entanto, não houve diferença estatisticamente significativa na média da pontuação OSDI na duração do diagnóstico (P=0.49), distribuição (P≥0,26), ou correlação (P=0,77). CONCLUSÃO: Uma grande proporção de pacientes brasileiros tratados com uma medicação para redução da PIO apresenta sintomas decorrentes de doença da superfície ocular (DSO).

Boston type 1 keratoprosthesis outcomes in ocular burns.

PURPOSE: To report the outcomes of Boston type I keratoprosthesis (BKPro) in the management of ocular burn injuries. METHODS: This was a prospective study including all cases of BKPro implantation for ocular burns at the External Diseases and Cornea Service of the Federal University of São Paulo, between February 2008 and February 2010. Ten patients (10 eyes) were enrolled. Procedures performed to manage ocular injury were identified, and data were collected regarding patients' ocular history, surgical procedure(s) performed, and postoperative outcomes, including visual acuity, retention, complications and required surgical procedures. RESULTS: A total of 11 Type 1 BKPro were implanted in 10 eyes of 10 patients. The mean follow-up period was 25.7 ± 10.8 months. Preoperative best-corrected visual acuity (BCVA) ranged from count fingers to light perception. Postoperative BCVA was better than 20/200 in 90% of the patients and better than 20/60 in 60% of the patients. The overall BKPro retention rate was 90%. The most common complications were retroprosthetic membrane formation (50%) and persistent corneal epithelial defect evolving to corneal melting (40%). Patients who underwent ocular surface procedures such as limbal transplantation prior to BKPRo implantation had a lower incidence of corneal melting/thinning (p = 0.07), although this was not statistically significant. CONCLUSION: The anatomical and functional results identified in this study support the use of BKPro in managing bilateral limbal stem cell deficiency secondary to ocular burns.

Peripheral sterile corneal ring infiltrate after riboflavin-UVA collagen cross-linking in keratoconus.

PURPOSE: To present 7 cases of peripheral sterile corneal infiltrates that occurred after corneal cross-linking (CXL) for progressive keratectasia. METHODS: Seven patients who had their progressive keratoconus documented underwent corneal deepithelization and subsequently CXL, which was performed with the application of 0.1% riboflavin with 20% dextran, and exposure to UVA light (370 nm, 2.9-3.1 mW/cm(2)) for 30 minutes. RESULTS: Nearly a week after the procedure, the patients presented with peripheral stromal infiltrates. The ring-like infiltrates were superficial and were present at the 9.0-mm zone. Sterile infiltration was diagnosed. Patients were treated with topical corticosteroids, and complete resolution was achieved after a few weeks of treatment. CONCLUSIONS: We hypothesize that the phototoxic effect on the corneal stroma may be the main mechanism that triggers these infiltrates. Alternatively, alterations in antigenicity that occur in native proteins after CXL could result in patients recognizing the proteins as nonself and mounting immune responses.

Toxicidade ocular por derivados da 4-aminoquinolona / Ocular toxicity due to 4-aminoquinoline derivatives

A toxicidade retiniana da cloroquina tem sido extensamente estudada desde a sua primeira descrição em 1957. Esta droga é usada no tratamento de várias doenças reumatológicas e dermatológicas, com tendência atual ao uso da hidroxicloroquina a cloroquina. A dose diária da droga parece determinar o desenvolvimento da doença ocular, não devendo ultrapassar 4 mg/kg/dia. O quadro clínico é caracterizado por escotoma paracentral no campo visual associado à maculopatia em " olho de boi" . O campo visual e a tela de Amsler são os exames que podem detectar mais precocemente as alterações tóxicas retinianas. O presente texto propõe uma revisão da patogênese, quadro clínico, diagnóstico diferencial, exames complementares e tratamento. Os autores utilizaram em sua pesquisa os bancos de dados da PubMed (MEDLINE), LILACS e Biblioteca do Centro de Estudos de Oftalmologia.

Retinal toxicity of chloroquine has been extensively studied since its first description in 1957. This drug is used on a chronic basis to treat several rheumatologic and dermatologic diseases, a there is a trend to use hydroxychloroquine rather than chloroquine. The recommended dose for hydroxychloroquine is 4 mg/kg lean body weight per day. The clinical picture of chloroquine retinopathy is characterized by a paracentral visual field scotoma with associated parafoveal retinal pigment epithelium atrophy, known as 'bull's eye maculopathy. The visual field and Amsler grids are the exams that early detect toxicity retinopathy. The authors aim to review the pathogenesis, clinical features, differential diagnosis, complementary exams, and treatment. The sources of references were PubMed (MEDLINE), LILACS and Ophthalmology Library databases.

[In vivo confocal microscopy in amiodarone corneal deposits]. / Microscopia confocal in vivo nos depósitos corneanos por amiodarona.

PURPOSE: To describe in vivo confocal microscopy findings in patients with different stages of amiodarone-induced keratopathy, and correlate biomicroscopy stages with confocal stages. METHODS: Twenty eyes of 10 patients (6 men and 4 women), who receive treatment with amiodarone were selected for the study with confocal microscopy (MC). RESULTS: The average age was 58 +/- 6.2 years (50-66 years) and time of use of the drug was 6 +/- 3.2 years (2-11 years). All patients have best correct visual acuity > or =20/40. There were two patients in stage 1, 4 patients in stage 2 and 4 in stage 3 of induced keratopathy. All corneas presented brilliant intracellular inclusions with high reflectivity in the basal epithelium layer. Patients in stage 2 and 3 have all corneal layers affected. There are thinning and increase of tortuosity of corneal nerves in patients in stage 2 and 3. The endothelial count was 2,524 +/- 150,3 cell/mm(2). CONCLUSION: The basal epithelium was most affected in any of the keratopathy stages. In stage 1 patients only the superficial and basal epithelium are affected, while patients in stages 2 and 3 have all corneal layers affected. With the advance of keratopathy the corneal nerves became thinner and tortuous.

Microscopia confocal in vivo nos depósitos corneanos por amiodarona / In vivo confocal microscopy in amiodarone corneal deposits

OBJETIVO: Descrever os achados da microscopia confocal in vivo em pacientes nos diversos estágios de ceratopatia induzida por amiodarona, e correlacionar o estadiamento biomicroscópico com o estadiamento confocal. MÉTODOS: Vinte olhos de 10 pacientes (6 homens e 4 mulheres) em tratamento com amiodarona, que apresentavam ceratopatia induzida pela droga, foram selecionados para o estudo, com a microscopia confocal (MC). RESULTADOS: A média de idade foi 58 ± 6,2 anos (50-66 anos) e o tempo de uso da droga foi de 6 ± 3,2 anos (2-11 anos). Todos pacientes tinham acuidade visual com correção melhor ou igual a 20/40. A biomicroscopia evidenciou ceratopatia por amiodarona: dois pacientes no estágio 1, quatro no estágio 2 e quatro no estágio 3. Todas as córneas apresentaram inclusões intracelulares brilhantes e de alta refletividade na camada epitelial basal. A partir dos estágios 2 e 3, foram encontrados microdepósitos em todas camadas corneanas. Foram observados afilamento e aumento da tortuosidade dos nervos corneanos nos estágios 2 e 3 da ceratopatia. A contagem endotelial média foi de 2.524 ± 150,3 células/mm². CONCLUSÃO: O epitélio basal foi o mais acometido nos diferentes estágios da ceratopatia. Nos pacientes do estágio 1 a biomicroscopia, os microdepósitos subepiteliais são restritos ao epitélio superficial e basal, ao passo que nos pacientes dos estágios 2 e 3, os microdepósitos afetam todas camadas corneanas. A medida que a ceratopatia avança, os nervos corneanos ficam mais afilados e tortuosos.

PURPOSE: To describe in vivo confocal microscopy findings in patients with different stages of amiodarone-induced keratopathy, and correlate biomicroscopy stages with confocal stages. METHODS: Twenty eyes of 10 patients (6 men and 4 women), who receive treatment with amiodarone were selected for the study with confocal microscopy (MC). RESULTS: The average age was 58 ± 6.2 years (50-66 years) and time of use of the drug was 6 ± 3.2 years (2-11 years). All patients have best correct visual acuity ³ 20/40. There were two patients in stage 1, 4 patients in stage 2 and 4 in stage 3 of induced keratopathy. All corneas presented brilliant intracellular inclusions with high reflectivity in the basal epithelium layer. Patients in stage 2 and 3 have all corneal layers affected. There are thinning and increase of tortuosity of corneal nerves in patients in stage 2 and 3. The endothelial count was 2,524 ± 150,3 cell/mm². CONCLUSION: The basal epithelium was most affected in any of the keratopathy stages. In stage 1 patients only the superficial and basal epithelium are affected, while patients in stages 2 and 3 have all corneal layers affected. With the advance of keratophaty the corneal nerves became thinner and tortuous.

[Ocular toxicity due to 4-aminoquinoline derivatives]. / Toxicidade ocular por derivados da 4-aminoquinolona.

Retinal toxicity of chloroquine has been extensively studied since its first description in 1957. This drug is used on a chronic basis to treat several rheumatologic and dermatologic diseases, a there is a trend to use hydroxychloroquine rather than chloroquine. The recommended dose for hydroxychloroquine is 4 mg/kg lean body weight per day. The clinical picture of chloroquine retinopathy is characterized by a paracentral visual field scotoma with associated parafoveal retinal pigment epithelium atrophy, known as 'bull's eye maculopathy. The visual field and Amsler grids are the exams that early detect toxicity retinopathy. The authors aim to review the pathogenesis, clinical features, differential diagnosis, complementary exams, and treatment. The sources of references were PubMed (MEDLINE), LILACS and Ophthalmology Library databases.

Indicaçäo indevida de anestésicos tópicos oculares / Improper indication of ocular topical anesthetics

O abuso de anestésicos tópicos oculares, apesar de infreqüente, é um problema potencialmente sério que pode resultar em danos corneanos e até diminuiçao ou perda permanente da visao. Com o objetivo de verificar a indicaçao indevida destas drogas nas "consultas de balcao", quatro acadêmicos de Medicina visitaram quarenta e sete farmácias de Caxias do Sul, queixando-se de sensaçao dolorosa em um dos olhos. Das farmácias consultadas, 32 por cento (15) indicaram colírios com nafazolina + berberina (Lerin) ou nafazolina + zinco (Moura Brasil), 23,5 por cento (11) anestésicos tópicos e apenas 12,7 por cento (6) recomendaram consulta com oftalmologista. Os autores revisam os danos oculares causados pelos anestésicos tópicos.

Lesäo corneana grave produzida por anestésico tópico / Grave corneal lesion produced by topical anesthetic

Os autores apresentam o caso de um paciente que teve graves lesöes corneanas pelo uso de tetracaina tópica. Recomendam que colírios anestésicos sejam fornecidos só com receita médica

[Amiodarone keratopathy. Prospective longitudinal study]. / "Queratopatía por amiodarona." Estudio longitudinal prospectivo.

In order to investigate the frequency of corneal micro-deposits of amiodarone and its relationship to age, sex, dose and treatment duration, we studied one-hundred-fifty consecutive patients from 1982 to 1986. The average age was 33.8 +/- 17.5 years for eighty woman and seventy men. The mean weekly dose was of 1.1 +/- 0.3 g and the duration was 23.7 +/- 15.3 months. A complete eye examination was performed in all cases. The corneal micro-deposits were classified in three levels according to their density. In one-hundred-fourteen cases there were corneal micro-deposits; sixty-nine had grade I, thirty grade II and fifteen grade III. None had visual disturbances. There was only a direct statistical correlation between age and micro-deposit levels. Nine cases had also deposits of pigment in the lens. Two cases presented atypical keratopathy which by their involution after withdrawal of the drug was considered to be amiodarone-related. Fifteen cases presented chronic blepharitis, and ten, chronic non-secreting conjunctivitis. Therefore, age is a determinant factor for corneal accumulation of amiodarone micro-deposits.